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STUDY DESIGN A retrospective study. OBJECTIVE To examine the preoperative patients with cervical spondylotic myelopathy(CSM) : (1)Whether cervical sagittal parameters are related to the progress of patients with CSM, (2)Can cervical sagittal parameters predict disease progression or prognosis in patients with CSM. SUMMARY of Background Data. Cervical sagittal parameters can guide the development of surgical planning. However, the correlation between cervical sagittal parameters and the progression of patients with CSM has not been reported. METHODS From 2015 to 2018, 126 preoperative patients with CSM were enrolled. The inclusion criteria included cervical lateral radiograph, flexion(F), extension(E), and some clinical function scores (VAS, mJOA, NDI, SF-36, PHQ-9). Health Transition(HT) was used to evaluate the patient's disease progress.The following radiographic parameters were measured: (1)C0-C2 lordosis, (2)C2-C7 lordosis, (3)C7 slope, (4)T1 slope, (5)C2-C7 sagittal vertical axis(SVA), (6)cervical tilt, (7)cranial tilt, (8)cervical curvature index (CCI), (9)CCI change constant(CCI-CC). Of the 126 patients, 101 chose surgical treatment. We followed up for one year and grouped the patients with C2-C7 Cobb angle(F) > 29°. We compared the prognosis of the surgical group and the disease progression of the non-surgical group. RESULTS In preoperative patients with CSM, mJOA was positively correlated with cervical tilt(E), cervical tilt(ROM), and CCI(ROM). The larger CCI-CC is the only independent risk factor for NDI increase. High C2-7F, low Cervical tilt, and low Cervical tilt(F) values are independent predictors of high HT scores. Whether in surgical group or non-surgical group, the recovery of patients with C2-7F>29° was better than that of patients with C2-7F≤29°. CONCLUSION In preoperative patients with CSM, The larger CCI-CC is the only independent risk factor for NDI increase. When the patient has a C2-C7 Cobb angle(F) >29°, the patient's condition progresses slowly.